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Case Reports
. 2021 May 12;14(5):e242489.
doi: 10.1136/bcr-2021-242489.

Subacute right ventricle perforation: a pacemaker lead complication

Emna Allouche  1   2 , Soumaya Chargui  3   4 , Marwa Fathi  1 , Leila Bezdah  1
Affiliations
Case Reports

Subacute right ventricle perforation: a pacemaker lead complication

Emna Allouche et al. BMJ Case Rep. .

Abstract

Myocardial perforation is an uncommon but potentially life-threatening complication of pacemaker and implantable cardioverter-defibrillator. Myocardial perforation may be acute, subacute or chronic when it occurs within 24 hours of the device insertion; between 1 day and 30 days; and more than 30 days after implantation. This complication may occur in 1.7%-7% of patients. However, subacute myocardial perforation is rare and affects 0.5%-1.2% of patients. We report the case of an 85-year-old patient with a pacemaker failure 10 days after implantation due to a subacute myocardial perforation caused by an active fixation ventricular lead. Transthoracic echocardiography showed penetration of the ventricular lead through the right ventricular apex into the pericardium without any pericardial effusion. We confirmed myocardial perforation by a CT scan. We referred her to the surgery ward where she was successfully managed.

Keywords: arrhythmias; pacing and electrophysiology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
A contrast venogram of the left upper limb showing obstruction of the subclavian vein.
Figure 2
Figure 2
The chest radiograph showing a loss of the italic S-shape of the ventricular lead (A) after insertion; (B) 10 days later.
Figure 3
Figure 3
Transthoracic echocardiography showing penetration of the ventricular lead through the right ventricular apex into the pericardium without any pericardial effusion.
Figure 4
Figure 4
CT revealing the right ventricle pacing lead perforating the myocardium and the tip lied between the visceral and parietal pericardium with mild pericardial effusion. (A, B) Axial sections; (C) sagittal section.
See this image and copyright information in PMC

References

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